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ANATOMY > abdomen clinical correlates > Flashcards

abdomen clinical correlates Flashcards

1
Q

what is paracentesis?

A

passing a needle through structures of abdominal wall to access peritoneal space for excess fluid removal

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2
Q

where is paracentesis performed? (hint: 2 places in the abdomen)

A

anteriorly - either midline through linea alba or laterally through muscular wall

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3
Q

generally, where do preganglionic sympathetic fibers synapse?

A

in prevertebral ganglia

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4
Q

what is the exception to preganglionic sympathetic synapsing?

A

the suprarenal medulla

(preganglionic sympatheti fibers from greater splanchnic nerve synapse directly on chromaffin cells located in suprarenal medulla)

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5
Q

what is the level of the greater splanchnic nerve?

A

T5-T9

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6
Q

where do preganglionic sympathetic fibers that synapse on the suprarenal medulla bypass?

A

celiac ganglion

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7
Q

ANS sympathetic visceromotor functions include:

A

decreased peristalsis and gland secretion
vasoconstriction
closure of sphincters

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8
Q

ANS parasympathetic visceromotor function includes:

A

increased peristalsis and gland secretion
vasodilation
opening of spinchters

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9
Q

what are esophageal varices?

A

enlarged veins in the esophagus

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10
Q

do esophageal varices occur proximally or distally?

A

distally

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11
Q

where do distal esophageal varices occur?

A

between tributaries of the left gastric vein (portal) and esophageal veins (caval)

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12
Q

what causes esophageal varices?

A

increased pressure in portal vein causing back flow of venous blood into smaller veins and dilation

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13
Q

what is portal hypertension?

A

an increase of pressure in the portal vein

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14
Q

what causes portal hypertension?

A

cirrhosis of the liver which casuses scar tissue

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15
Q

true or false: very little blood returns through the hepatic vein into the inferior vena cava

A

true

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16
Q

true or false: scar tissue obstructs blood flow through liver

A

true

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17
Q

what causes a barrett esophagus?

A

GERD (gastroesophageal reflux disease)

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18
Q

what is the clinical importance of metaplastic invasion that occurs with barrett esophagus?

A

almost all lower esophageal adenocarcinomas occur as a sequela

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19
Q

why does the liver’s position change with respiration?

A

due to the relationship with the diaphragm and thoracic cage

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20
Q

with expiration, the diaphragm is _____ and the liver is ______

A

diaphragm = domed
liver = elevated

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21
Q

with inspiration, the diaphragm is ____ and the liver is _____

A

diaphragm = flattened
liver = depressed

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22
Q

mobility of the liver during respiration can aid in palpation to assess what?

A

palpation of the inferior margin to assess liver size and position

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23
Q

what is palpation of the inferior margin important for?

A

screening for hepatitis and metastatic carcinoma (causes hepatomegaly)

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24
Q

when the liver is enlarged, what happens to the inferior margin?

A

it can be easily palpated because it extends well beyond the inferior border of the ribs

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25
Q

what does liver cirrhosis cause?

A

portal hypertension

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26
Q

in liver cirrhosis, what does increased type 1 collagen narrow?

A

the diameter of the sinusoid

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27
Q

what is caput medusae?

A

portal hypertension clinically represented by varicosities around umbilical anastomosis where the paraumbilical veins in the subcutaneous fascia of anterior abdominal wall become distended

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28
Q

what causes caput medusae?

A

when blood flow in the portal vein is reversed and forced into the caval system at portal caval anastomosis

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29
Q

what is caput medusae named after?

A

the appearance of the varicosities resembles the head of the medusa

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30
Q

what is an abdominal aortic aneurysm?

A

a true aneurysm which
1. the diameter of the aortic lumen is 50% larger than that of the normal aortic lumen diameter
2. dilation is segmental
3. full thickness of vessel is affected

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31
Q

where do abdominal aortic aneurysms mostly occur? what level is this at?

A

between the renal and inferior mesenteric arteries (L1-L3)

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32
Q

what are risk factors for abdominal aortic aneurysms? (hint: 5)

A
  1. being male
  2. atherosclerosis
  3. hypertension
  4. family history
  5. age
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33
Q

what are abdominal aortic aneurysms symptoms (pre-rupture)

A
  1. abdominal, back, or flank pain
  2. poor circulation
  3. potential ischemia in lower limbs
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34
Q

what are symptoms of a ruptured abdominal aortic aneurysm?

A
  1. hypotension
  2. delirium
  3. severe central abdominal pain that radiates to spine
  4. abdominal mass with pulse (in 50% of cases)
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35
Q

what is the BBC approach for interpreting abdominal radiographic images?

A

bowel (and other organs)
bones
calcifications (and calcifications)

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36
Q

what is the purpose of a stepwise fashion for interpreting radiographic images?

A

minimizes errors and maximizes the effectiveness of a treatment plan

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37
Q

what should you look for in small and large bowels during imaging analysis?

A

mucosal fold patterns

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38
Q

explain small bowel folds

A

span the fill width of the bowel

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39
Q

explain large bowel folds

A

do not completely traverse the large bowel

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40
Q

what is the stepwise fashion for all radiology besides bowel?

A

lungs
liver
gallbladder
stomach
psoas muscles
kidney
spleen
bladder
bones
calcifications and artifacts

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41
Q

what part of the lungs are assessed for pathology?

A

the bases

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42
Q

what quadrant is the liver in, and what should be assessed for the liver in radiology?

A

right upper quadrant - assess size

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43
Q

what organ is difficult to see on an x-ray?

A

the gallbladder

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44
Q

where are the psoas muscles located?

A

in the lumbar region

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45
Q

what should be analyzed on the psoas muscle in radiology?

A

demarcation on the lateral edge (psoas fat plane)

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46
Q

which kidney is more visible in radiology?

A

the right kidney

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47
Q

where does the spleen lie? (what quadrant and next to what organ?)

A

left upper quadrant
superior to left kidney

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48
Q

spleen _____ should be looked for in radiology

A

enlargement

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49
Q

the variable size of the bladder depends on ______

A

its fullness

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50
Q

bones are used for ______ when assessing organ radiology

A

landmarks

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51
Q

what is the order you should proceed in when analyzing bones

A

ribs > lumbar vertebrae > sacrum > coccyx > pelvis > proximal femurs

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52
Q

what are examples of calcifications that can be visualized on abdominal x-rays?

A

gallstones, renal stones
pancreatic, vascular, and costochondral calcifications

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53
Q

what are examples of artifacts that may be visualized on abdominal x-rays?

A

surgical clips, jewelry (umbilicus), intrauterine device

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54
Q

T or F: gas patterns can be visualized in abdominal x-rays

A

true

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55
Q

what is essential for diagnostic and interventional radiology?

A

a solid understanding of the spatial arrangement of structures

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56
Q

what is the systematic approach to interpreting abdominal CT images?

A

identifying abdominal wall layers, peritoneal spaces/structures, normal fat planes, and solid organ location and features.

57
Q

you should work ______ to _____ for a thorough interpretation of abnormal anatomy and pathology

A

superficial to deep

58
Q

when viewing axial CT images, the patients feet are _____ __ of the plane of the image and the head is _____ the plane of the image

A

feet = coming out
head = into

59
Q

organizing viscera into ______ _____ can help to determine positions in stacked (CT) images

A

abdominal quadrants

60
Q

where does excess peritoneal fluid collect?

A

in the rectovesicle pouch (men)
in the rectouterine pouch (females) (pouch of douglas)

61
Q

where is excess peritoneal fluid accessed in males?

A

through the umbilicus

62
Q

where is excess peritoneal fluid accessed in females?

A

posterior fornix of the cervix

63
Q

visceral pain fibers (GVA) from the appendix travel with the ______ fibers back to the T__ spinal cord segment

A

sympathetic fibers back to the T10

64
Q

referred visceral pain from the appendix is located where?

A

around the umbilicus

65
Q

what dermatome is the umbilicus?

A

T10

66
Q

Inguinal hernias are described as being either ____ or _____.

A

direct or indirect

67
Q

An inguinal hernia results from abdominal contents—typically _____ ______—protruding through the abdominal body wall in the inguinal region.

A

small bowel

68
Q

A _____ inguinal hernia occurs medial to the inferior epigastric vessels, where contents typically protrude through the superficial ring in the inguinal (Hesselbach) triangle.

A

direct

69
Q

An _____ hernia occurs lateral to the inferior epigastric vessels, where contents protrude through the deep inguinal ring and canal into the scrotum

A

indirect

70
Q

Direct inguinal hernias are more common in _____ males

A

aged

71
Q

Indirect inguinal hernias are more common in _____ males

A

younger

72
Q

indirect inguinal hernias are often a result of ____ ______ _____

A

patent processus vaginalis

73
Q

______ of the peritoneum can occur as a result of visceral rupture (e.g., appendix), visceral fluid escape into the peritoneal cavity, penetration of the peritoneal cavity (e.g., stab wound), or contact between enlarged viscera and surrounding peritoneum

A

inflammation

74
Q

Inflammation of the parietal peritoneum presents with….

A

sharp, localized pain, rebound tenderness and reflexive guarding with palpation in the area of inflammation

75
Q

what is peritonitis?

A

inflammation and infection of the peritoneum

76
Q

how is peritonitis treated?

A

cavity washout with sterile saline and antibiotics

77
Q

The ______ _______ plays a protective role during inflammation and infection in the peritoneal cavity such that it can isolate and seal off the damaged region and acts as the principle site for migration and proliferation of macrophages and neutrophils.

A

greater omentum

78
Q

what is nutcracker syndrome?

A

compression of the left renal vein by overlaying superior mesenteric artery

79
Q

explain the course of the left renal vein

A

courses across the abdominal aorta, just posterior to the SMA to reach
the left kidney

80
Q

compression of the left renal vein limits/occludes in what?

A

drainage of venous blood from the left kidney to the IVC

81
Q

what does nutcracker syndrome cause?

A

left flank pain and renal hypertension with subsequent venous
rupture within the kidney, resulting in blood in the urine (hematuria)

82
Q

how does nutcracker syndrome differ from SMA syndrome (wilkie syndrome)?

A

wilkie syndrome compresses the horizontal 3rd part of the duodenum causing visceral obstruction (not vascular obstruction)

83
Q

what is Gastroesophageasl reflux disease?

A

the symptoms or mucosal damage produced by the abnormal reflux of gastric contents through the lower esophageal sphincter (LES) into the esophagus

84
Q

describe the pathological findings of GERD

A
  1. hyperemia (engorgement of blood)
  2. superficial erosions and ulcers which appear as vertical linear streaks
  3. hydropic changes in the stratified squamous epithelium along
  4. increased lymphocytes, eosinophils, and neutrophils.
85
Q

describe clinical features of GERD

A
  1. heartburn (pyrosis), which may worsen when bending or lying down
  2. regurgitation
  3. dysphagia (difficulty in swallowing)
86
Q

what are causes for dysphagia?

A

esophageal cancer (adenocarcinoma from barrett metaplasia or squamous cell carcinoma)

87
Q

A hiatal hernia occurs when a portion of the stomach herniates through the
_______ _____ in the diaphragm

A

esophageal hiatus

88
Q

what are the 2 categories of hiatial hernias?

A

sliding and paraesophageal

89
Q

In a ______ hiatal
hernia, the Z-line that marks the mucosal transition between the esophagus
and stomach slides superiorly with the herniation of stomach (cardia).

A

sliding

90
Q

In a ________ hiatal hernia, the normal anatomical location of the Z-line is
maintained, and the portion of stomach (fundus) and associated peritoneum
protrudes through the hiatus, just anterior to the esophagus.

A

paraesophageal

91
Q

what is Primary biliary cirrhosis?

A

an autoimmune disease characterized by
a CD8+ cytotoxic T-cell–mediated attack on intrahepatic bile ductules

92
Q

_______ _______ has been speculated to initiate the T-cell–mediated attack in primary biliary cirrhosis

A

Molecular mimicry

93
Q

Molecular mimicry occurs when….

A

foreign antigens stimulating an immune response have enough similarity to “self” proteins that the
immune response “spills over” to attack normal tissues.

94
Q

_____ is characterized by the presence or formation of gallstones either in the gallbladder (called cholecystolithiasis) or common bile duct (called choledocholithiasis).

A

cholelithiasis

95
Q

what do most gallstones consist of?

A

cholesterol (major component)
bilirubin
calcium

96
Q

what stones are yellow to tan, round or faceted, smooth, and single or multiple. These stones are composed mainly of cholesterol.

A

cholesterol stones

97
Q

what stones are black, irregular, glassy upon cross section, and <1 cm in diameter. They are composed mainly of calcium bilirubinate, bilirubin polymers, other calcium salts, and mucin.

A

black pigment stones

98
Q

what stones are brown, spongy, and laminated. They are composed mainly of calcium bilirubinate, cholesterol, and calcium soaps of fatty acids.

A

brown pigment stones

99
Q

______ is the clinical manifestation of inflammation of the pancreas

A

pancreatitis

100
Q

_____ ______ is characterized by a sudden onset of epigastric pain that is often exacerbated when the patient is supine

A

acute pancreatitis

101
Q

what is the primary cause of pancreatitis?

A

obstruction of the hepatopancreatic ampulla from a gallstone

102
Q

T or F: the main pancreatic duct can lose patency with swelling of the pancreatic head.

A

true

103
Q

_______ ____ of pancreatic products and bile may also occur as a
result of the blockage

A

retrograde flow

104
Q

On __, the pancreas typically
looks enlarged with poorly defined margins due to edema

A

CT

105
Q

_____ _____ _____ is the most common cause of chronic pancreatitis.

A

chronic alcohol abuse

106
Q

type ___ diabetes marked by autoantibodies and an insulitis reaction that results in the destruction of pancreatic β cells

A

type 1

107
Q

T or F: type 1 diabeties is a multifactorial disease

A

true

108
Q

The clinical features of type I diabetes include

A

hyperglycemia, ketoacidosis, and exogenous insulin dependence

109
Q

Long-term clinical effects of type I diabetes include…

A

neuropathy, retinopathy leading to blindness, and nephropathy leading to kidney failure.

110
Q

Type __ diabetes is marked by insulin resistance of peripheral tissues and abnormal a cell function and is often associated with obesity

A

type 2

111
Q

T or F: type 2 diabetes is multifactorial

A

True

112
Q

how is type 2 diabetes found

A

often detected during routine screening by detection of hyperglycemia or by patient complaining of polyuria.

113
Q

splenomegaly can be caused by what 3 things?

A

hepatic pathology, hematologic pathology, and infection

114
Q

T or F: the liver should not be easily palpated in the normal person

A

true

115
Q

what is An ileal diverticulum (Meckel diverticulum)?

A

occurs when a remnant of the vitelline duct persists, thereby forming an outpouching located
on the antimesenteric border of the ileum

116
Q

where is an ileal diverticulum usually located?

A

sually located about 30 cm proximal to the ileocecal valve in infants and varies in length from 2 to 15 cm

117
Q

Heterotopic gastric mucosa may lead to…

A

ulceration, perforation, or GI bleeding, especially if a large number of parietal cells are present

118
Q

list symptoms of ileal diverticulum

A

symptoms resembling appendicitis and bright red or dark red stools (i.e., bloody).

119
Q

what is chron disease?

A

a chronic inflammatory bowel disease that usually appears in teenagers and young adults

120
Q

chron disease usually affects…

A

the ileum and the ascending right colon.

121
Q

what is chron disease caused from?

A

etiology of CR is unknown, although epidemiologic studies have indicated a strong genetic predisposition, and immunologic studies have indicated a role of cytotoxic T cells in the damage to the intestinal wall

122
Q

explain pathological findings of chron disease

A

Pathologic findings include
1. transmural nodular lymphoid aggregates
2. noncaseating epithelioid granulomas
3. neutrophil infiltration of the intestinal glands that ultimately destroys the glands leading to ulcers
4. coalescence of the ulcers into long, serpentine ulcers (linear ulcers) oriented along the long axis of the bowel

123
Q

what is a classic feature of chron disease?

A

he clear demarcation between diseased bowel segments located directly next to uninvolved normal bowel and a cobblestone appearance that can be seen grossly and radiographically.

124
Q

what is appendicitis?

A

acute inflammation of the appendix caused by blockage of theorgan’s small lumen by fecal concretion (older patients) or by lymphoid hyperplasia(younger patients).

125
Q

Luminal obstruction causes distention and may lead to ______ of the appendix

A

rupture

126
Q

explain referred pain that occurs with appendicitis

A

The pattern of referred visceral pain associated with appendicitis begins in the periumbilical region (dull in nature) and migrates to the lower right quadrant.

127
Q

list signs and symptoms of appenndicitis

A

Nausea, vomiting, and fever are often present. Irritation of the parietal peritoneum adjacent to the appendix often causes severe pain, which presents with rebound tenderness and guarding

128
Q

Pressure over the ________ point (midpoint along the line from the right anterior superior iliac spine to theumbilicus) produces this point tenderness

A

McBurney

129
Q

T or F: CT and utrasound can be used to assess appendicitis

A

true

130
Q

what is ulcerative colitis? (UC)

A

an idiopathic inflammatory bowel disease
that usually appears in teenagers and young adults

131
Q

UC always involves the _______ and may extend proximally for varying distances into the _______ colon

A

rectum
descending colon

132
Q

what are the pathological findings of UC?

A

aw, red, and granular mucosal surface;
continuous inflammation (i.e., no “skip areas” as in Crohn disease); a diffuse, chronic inflammatory infiltration in the lamina propria; damage to the intestinal glands (crypts); inflammatory pseudopolyps; areas of friable, bloody residual mucosa; “collar-button” ulcers; and “lead-pipe” appearance in the chronic state.

133
Q

EMBRYO: what is an omphalocele?

A

omphalocele occurs when abdominal contents herniate through the umbilical ring and persists outside the body, covered variably by a
translucent peritoneal membrane sac (a light gray, shiny sac) protruding from the base of the umbilical cord.

134
Q

what is the difference between large and small omphalocele?

A

Large omphaloceles may contain stomach, liver, and intestines. Small omphaloceles contain only intestines.

135
Q

omphaloceles are usually associated with other congenital anomalies and with increased levels of alpha _________

A

fetoprotein

136
Q

______ ______ (Hirschsprung disease) is caused by the arrest of the caudal migration of neural crest cells.

A

Colonic aganglionosis

137
Q

________ hernias in newborns occur at the site of an incompletely closed umbilicus

A

Umbilical

138
Q

in umbilical hernias, what may herniate?

A

peritoneum, fat, or bowel

139
Q

Unlike ________, umbilical hernias do not involve failed return of intestines from the umbilical cord back into the abdominal cavity.

A

omphaloceles

ANATOMY (3 decks)

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